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Stephanie Pellitt

Policy and Advocacy Associate

32 States Get A Failing Grade on Parity

October 4, 2018 | Parity | Comments
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A newly released report evaluates the strength and quality of state laws created to ensure that health insurers treat illnesses of the brain, such as depression and substance use disorders, the same way they treat illnesses of the body, such as diabetes and cancer. The report assigns failing grades to 32 states, while the state of Illinois is identified as having a model state statute. The report offers recommendations for how states can improve their parity laws to ensure equal access to mental health and substance use disorder treatment.

This week marks the 10th anniversary of the Mental Health Parity and Addiction Equity Act (MHPAEA)—the federal parity law that requires that mental health and substance use disorder (SUD) treatment services be covered by insurance the same way as medical and surgical services. While gains in behavioral health coverage have been made, many individuals and families continue to report being denied or charged more for necessary mental health and SUD treatments by their health care plan. The report’s authors argue that in light of the opioid crisis and rising rates of suicide, state lawmakers must make the full realization of parity a priority.


The states that scored the lowest on the report’s Statutory Coding Index included Wyoming, Arizona, Idaho, and Indiana. Illinois, Tennessee, Maine, Alabama, Virginia and New Hampshire received the highest parity scores. Illinois was given a perfect score (100/100 points) and thus was highlighted as a potential model other states could follow.

To strengthen their parity statutes, the authors recommended that states do some or all of the following (based on their state’s specific analysis):

  • Define mental health and substance use conditions to include all disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) with no exclusions.
  • Expand coverage with a benefit management process that requires copays and out-of-pocket costs for mental health and substance use services be the same as for physical illnesses.
  • Monitor and strengthen enforcement of compliance with the Federal Parity Law by mandating all health benefit plans submit annual analyses demonstrating compliance.  

Access the state-by-state report cards here and find an explanation of the scoring methodology in the following Technical Report. The report was produced by the Kennedy Satcher Center for Mental Health Equity (KSCMHE) within the Satcher Health Leadership Institute (SHLI) at Morehouse School of Medicine (MSM), in partnership with an expert coalition of organizations who support its findings, such as The Kennedy Forum, The Carter Center, and The Well Being Trust.